It takes a big person to admit they’re wrong- which means I’m morbidly obese.
I have posted in the past that Juvederm with numbing medicine is a waste of money. I’m wrong!
I was given a tester syringe of Juvederm XC, the Juvederm with numbing medicine in it. I put that syringe on the right side of a patient, and used regular Juvederm on the left side of the patient. My patient said that the Juvederm XC had substantially less pain, about a 2 out of 10. The regular Juvederm had a pain level of 5 out of 10. This patient is tough, and has had many other previous injections in the past several years. She was delighted to have the Juvederm XC.
Juvederm XC is regular Juvederm mixed with powdered numbing medicine inside the syringe. They make 2 kinds, Juvederm XC (lasts about 9 months), and Juvederm XC Ultra Plus (lasts about 12 months). They’re both a little more expensive than regular Juvederm, but I think it’s worth the price for alot less pain.
Below is propaganda, er video, of the introduction of Juvederm XC.
You should consider signing up for the Facebook link. I have no inside information at all, but I suspect that Allergan will send out coupons for Juvederm XC some day to people following them on Facebook.
http://www.facebook.com/Juvederm
Finally, here’s a picture of me with Dayna at the ASAPS meeting. She is a very funny and personable spokesperson.
Please note that I’m not paid by Allergan or anyone else, for this blog post. In fact, I’m starting to realize I should be paid by Allergan!
I just read an article in the New York TImes, “Awake for Breast Implants? If You Wish”.
It came out on April 8, 2010- http://www.nytimes.com/2010/04/08/fashion/08skin.html
This article shows the importance of board certification, or lack thereof.
Some doctors, but notice NOT plastic surgeons, say that they can give you a breast augmentation with local numbing medicine and sedation. This allows you, as the patient, to be more awake during the procedure, so that you can assist in the sizing of the breast implants. They also claim that there is actually less pain.
First, dear reader, please note that NONE of the doctors are actually board certified plastic surgeons. They have taken weekend courses or read stuff on their own or stayed at a Holiday Inn Express to do breast augmentation surgery. Plastic Surgery is tough enough with the training- I wouldn’t enjoy being the person responsible for sedation during the operation as well.
Breast augmentation is painful right when I’m creating the pocket. To just give sedation, the patient would still probably move around alot. Even though you may not remember the experience, your body would sense the pain and move around ALOT. It’s not pleasant as a doctor and fellow human being to watch, and also, I don’t want you to move anyway, so I prefer that you’re so anesthetized that you’re not feeling pain and you’re not moving. Generally, that requires another nurse or doctor present to give you the anesthesia.
I also assume that these surgeons are technically awesome, because when you’re moving during the pocket dissection, care must be taken not to have a pneumothorax, which is a hole created in the lung cavity, causing your lung to collapse. If I ever did that to a patient, at least I would know what to do, since I did general surgery and thoracic surgery training right after medical school. Somehow, I doubt a family practice doctor or OB/GYN would have the faintest idea what to do with such a big complication.
Another small point is that there’s nothing stopping these doctors from giving you TONS of sedation. So, even if you’re getting local anesthesia with sedation, you may be very sleepy to the point of needing assistance with breathing during the procedure. Again, even with monitoring equipment, you may still want a CRNA or MD anesthesiologist around to monitor you. I can’t do much immediately, since I’m sterile and presumably operating on you.
Finally, as a plastic surgeon, I have hospital privileges to do all types of cosmetic surgery, including breast augmentation. I feel that some of these doctors probably could not get hospital privileges for breast augmentation, and they’re forced to do it at their office. They could still get their office operating rooms fully certified by their local state, but it confuses me as to why some of the do not.
If an operating room is certified, then that means it’s passed tests for patient safety. The lighting, sterility of the room, equipment, backup power, etc., has all passed testing. If hospitals have to be certified, and operating rooms I use as a member of ASAPS have to be certified, why can’t every doctor in this article use an operating room that’s certified?
I think that local anesthesia for breast augmentation is probably more of a gimmick than standard practice, and has many drawbacks. I hope this article sheds a little light on some of the practical difficulties with just local anesthesia during a relatively painful procedure.
This year marks the 50th anniversary of the good, old-fashioned copy machine. But, as Armen Keteyian reports, advanced technology has opened a dangerous hole in data security.
Dr. Roy Kim, Plastic Surgeon in San Francisco, discusses breast volume and patient expectations to figure out “how big is too big” in breast augmentation.
